Poorer graft survival in African-American transplant recipients cannot be explained by HLA mismatching.

African-American kidney-transplant recipients have exhibited a higher rate of graft failure than whites and other patient groups. Many have attributed this discrepancy to disparities in HLA matching against a predominantly white donor pool. We compared the relative risks of cadaveric and living-related graft failure in African-American, white, Hispanic, and Asian transplant recipients, adjusting for a variety of demographic and clinical covariates. The relative risks of graft failure were increased by 44% and 73% in African-American recipients of cadaveric and living-related organs, respectively. Although Asians were subject to a comparable degree of HLA mismatching, cadaveric graft survival in Asian recipients was superior to that in whites. These results suggest that other variables not captured by registry data account for the increase in graft failure observed in African-Americans. More focused investigation into the causes and prevention of graft failure in African-Americans is required.